{
  "abstract": "Background: Patients with diabetic foot ulcers (DFUs) who undergo repeat wound culture and subsequent Pseudomonas aeruginosa (PA) detection form a selected clinical trajectory. Early-admission serum albumin reflects inflammation, capillary permeability, hepatic synthesis, protein loss, hydration, and nutritional reserve; it is not a stand-alone measure of nutritional status. We examined its association with hospitalization burden conditional on this serial-culture trajectory.\n\nMethods: This single-center retrospective cohort included 408 hospitalized patients with DFU who had a PA-positive wound culture after an earlier non-PA culture during the same admission. Because cohort eligibility required continued hospitalization until repeat sampling and later PA detection, inference was conditional on a post-admission selection event susceptible to immortal-time and collider-selection bias. The culture sequence was an operational ascertainment pattern, not evidence of nosocomial acquisition, microbiological conversion, or invasive PA infection. The co-primary outcomes were length of stay (LOS) and institution-specific nominal hospital charges. Negative binomial and gamma log-link models estimated adjusted within-cohort associations. Exploratory prognostic analyses used bootstrap optimism correction and same-center temporal assessment (development, 2013–2016; assessment, 2017–2018).\n\nResults: Among 408 patients [261 men (64.0%)], median LOS was 14 days [interquartile range (IQR), 9–19] and median nominal hospital charges were CNY 18,708 (IQR, 12,532–27,979). Compared with albumin ≥35 g/L, albumin 30 to <35 g/L was associated with longer LOS [adjusted rate ratio (aRR), 1.24; 95% CI, 1.10–1.40] and higher charges [adjusted charge ratio (aCR), 1.28; 95% CI, 1.12–1.46]; corresponding estimates for albumin <30 g/L were 1.52 (95% CI, 1.29–1.78) and 1.67 (95% CI, 1.40–1.99). Per 5-g/L lower albumin, the aRR for LOS was 1.19 (95% CI, 1.14–1.25) and the aCR for charges was 1.22 (95% CI, 1.16–1.28). Baseline-only estimates changed by less than 3% on the log-ratio scale. Adding albumin increased the apparent area under the curve (AUC) from 0.679 to 0.758 (optimism-corrected, 0.643 to 0.729; ΔAUC, 0.079; bootstrap 95% CI, 0.036–0.120). In the same-center temporal assessment sample (126 patients; 50 events), the AUC was 0.592 for the core model and 0.719 after albumin was added; corresponding Brier scores were 0.234 and 0.204, and calibration slopes were 0.625 and 0.994. These small-sample performance estimates were treated as descriptive. The median bootstrap-optimal albumin cutoff was 35 g/L (95% bootstrap percentile interval, 33–37 g/L).\n\nConclusions: Within this selected serial-culture cohort, lower early-admission albumin was associated with greater hospitalization burden and with numerically better exploratory prognostic performance in same-center analyses. These findings do not establish causality, transportability, a diagnosis of malnutrition, or a clinically actionable albumin threshold.",
  "abstract_shown": true,
  "affiliations": [
    "Affiliated Hospital of Shandong Second Medical University , , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Feifei Kan"
    },
    {
      "affs": [
        0
      ],
      "name": "Aihong Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Youliang Tan"
    },
    {
      "affs": [
        0
      ],
      "name": "Huizhen Dai"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b6yrmks0rs2m6.bib",
  "cited_by": 0,
  "doi": "10.3389/fendo.2026.1918069",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668586/?tool=EBI",
  "id": "b6yrmks0rs2m6",
  "issns": [
    "1664-2392"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13668586",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2712|Diabetic Foot Ulcer Assessment and Management"
    ]
  ],
  "openalex": "W7215040242",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668586/pdf/?tool=EBI",
  "pmcid": "PMC13668586",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/b6yrmks0rs2m6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:25Z",
      "native_id": "PMC:PMC13668586",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13668586"
    },
    {
      "first_seen": "2026-10-30T12:20:20Z",
      "native_id": "10.3389/fendo.2026.1918069",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1918069/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Diabetic Foot Ulcer Assessment and Management",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Early-admission serum albumin and hospitalization burden in a selected serial-culture cohort of patients with diabetic foot ulcers and subsequent Pseudomonas aeruginosa detection: a retrospective cohort study",
  "title_text": "Early-admission serum albumin and hospitalization burden in a selected serial-culture cohort of patients with diabetic foot ulcers and subsequent Pseudomonas aeruginosa detection: a retrospective cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:20Z",
  "url": "https://research.draconitic.com/paper/b6yrmks0rs2m6",
  "venue": "Frontiers in endocrinology",
  "versions": []
}